Paget disease of bone (osteitis deformans) is a focal disorder of bone remodelling, most commonly affecting the pelvis, lumbar spine, femur, tibia, and skull. Abnormal osteoclast activity followed by disorganised new bone formation produces bone that is enlarged, structurally weakened, and prone to deformity. In the lower limbs, Paget disease can produce progressive bowing of the femur and tibia, altered limb mechanics, hip and knee osteoarthritis (secondary to altered joint alignment), and an elevated risk of pathological fracture.
How Paget Disease Affects Walking
- Tibial and femoral bowing: Progressive bowing of the tibia (the characteristic sabre shin appearance) or femur alters the mechanical axis of the lower limb, increasing medial compartment loading at the knee and hip. This accelerates secondary osteoarthritis
- Secondary osteoarthritis: Altered joint alignment from Paget bone deformity produces early and rapidly progressive hip and knee osteoarthritis. This is often the primary walking-limiting feature
- Bone pain: Paget disease produces dull, deep bone pain that worsens with prolonged weight-bearing
- Pathological fracture risk: Pagetic bone is structurally weakened despite being enlarged. Fractures through pagetic bone (commonly the femoral shaft or tibia) can occur with low-energy impacts
- Spinal involvement: Vertebral enlargement causes spinal canal stenosis and nerve root compression, producing neurogenic claudication or radiculopathy
Cane Role in Paget Disease
A cane addresses Paget disease walking limitations in two primary ways:
- Load reduction on weakened bone and secondary OA: Contralateral cane reduces the ground reaction force through the affected limb during single-leg stance, reducing both the load on pagetic bone (fracture risk) and the secondary osteoarthritis load
- Gait stabilisation with altered alignment: Tibial or femoral bowing changes the lever arms of the lower limb, reducing gait stability. A cane provides an external stability point
Paget Disease Feature and Cane Role
| Paget Feature | Walking Impact | Cane Role |
|---|---|---|
| Tibial/femoral bowing | Altered mechanical axis; increased medial knee loading | Contralateral cane reduces medial compartment load |
| Secondary hip/knee OA | Joint pain, reduced range of motion | Contralateral cane; standard OA cane protocol |
| Bone pain (weight-bearing) | Pain increasing with walking distance | Cane reduces weight-bearing load; cushioned tip reduces impact |
| Pathological fracture risk | High-energy impact risk | Cane reduces impact loading on affected bone; fall prevention |
| Spinal Paget stenosis | Neurogenic claudication | Forward lean support; cane extends claudication threshold |
Explore DaiWalk walking canes. Related: Walking Cane for Osteoporosis | Walking Cane for Hip Osteoarthritis
